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8/2/2019 TS MD and Nurses Mechanics

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Programmatic Management of

Drug-resistant Tuberculosis

PMDT Training for Treatment Site

Physicians & Nurses

Grand Opera Hotel Manila, Sta. Cruz, City of Manila

November 14 - 18, 2011


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PMDT Training for Treatment Site

Physicians & Nurses

BACKGROUND AND MECHANICS

OF THE TRAINING

Grand Opera Hotel Manila, Sta. Cruz, City of Manila

November 14 - 18, 2011


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Definitions

Drug-resistant TB Mono-resistant TB: TB in patients whose

infecting isolates of M. tuberculosis are confirmed

to be resistant in vitro to one first-line anti-TB

drug

Poly-resistant TB: TB in patients whose infecting

isolates are resistant in vitro to more than onefirst-line drug other than both Isoniazid and

Rifampicin


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Definitions

Drug-resistant TB

Multidrug-resistant TB (MDR-TB): is active TB

involving M. tuberculosis organism that areresistant to at least Isoniazid AND Rifampicin,the two most powerful anti-TB agents. AnMDR-TB strain can be resistant to more thanthese two antibiotics.


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Estimated % of New TB

cases with MDR TB

Estimated % of

Retreatment TB cases

with MDR TB

Global 3.4 20

Western Pacific

Region (WPR)

4.9 23

High

MDR TB Burden

Countries

3.8 21

Philippines 4.0 21

Estimated Proportion of TB Cases

that Have MDR - TB


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Estimated Notified Enrolled on

Category IV Tx

Global 290,000 53,108 (18%) 45,553 (85.8%)

WesternPacific

Region

(WPR)

77,000 4,222 (5.4%) 2,210 (52.3%)

HighMDR TB

Burden

Countries

250,000 46,748 (18.6%) 38,652 (82.7%)

Philippines 8,800 522 (5.9%) 548

Number of MDR TB

Estimated, Notified, Enrolled in 2010


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A collective strategy using the different

components of the national TB control

program to effectively manage drug-resistant

tuberculosis.

It include activities on case detection,

treatment, surveillance, monitoring and

evaluation of the programs performance.

What is PMDT?


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Detect & Treat 15,000

MDR-TB Cases by 2016

MDG: To reduce

prevalence and

mortality by half by

the year 2015National TB

Control ProgramCase detection rate: > 85%

Success rate: > 90%

TB in

Adult

TB inChildren

PMDT

TB/HIV

ACSM

PPMD

CATCH TBTB in

Prison

PMDT

2010 2016 Philippine Plan of Action to Control Tuberculosis. Department of Health, Philippines


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Rationale for PMDT


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Rationale for PMDT


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Rationale for PMDT


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MDR-TB Management Framework

5 ELEMENTS OF DOTSTB

Political commitment

Quality assured

microscopy

Supervised treatment

PMDT

Sustained Political commitment

Rational case finding: accurate

& timely diagnosis through

quality assured culture and DST

Appropriate treatment

strategies that utilize 1st and 2nd

line drugs under proper

management conditions

P


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MDR-TB Management Framework

Regular availability of1st line drugs

Standardized records &

reports

Uninterrupted supply of qualityassured 1st and 2nd line drugs

Standardized recording and

reporting system designed for

DR-TB program

5 ELEMENTS OF DOTSTB MDR-TB


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Category IV Treatment

Category IV Treatment is a complex and very

long process that usually lasts from 18 to 24

months

It is critical to ensure that DR-TB patients adhere

to treatment until successful completion

because: DR-TB treatment is the last therapeutic option for

many patients

There is serious public health consequence if

therapy fails


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Main Treatment Center

Hospitals, PPMDs, DOTS

facilities, housing facilities

Satellite Treatment

Center

Hospitals, PPMDs, DOTS

facilities

Treatment Site

PPMDs, DOTS

facilities, NGOs, FBOs

Ambulatory

management of

DR-TB cases atPMDT facilities


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Designed to enable health care staff to provide

quality management of DR-TB cases at the level

of local health facilities as treatment sites.

Treatment site staff eligible for training include

DOTS facility physicians and nurses who will

directly provide management for DR-TB cases. 5-day comprehensive course composed of

modular training with individual and group

exercises and field visits to treatment facilities

PMDT Training of Treatment SitePhysicians & Nurses


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Modules A to G (Day 1

to Day 4)

Module H (Day 5)

Field Visit at Treatment

Center (SPMC)



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SILENT READING to allow participants work

through the modules at their own pace

Facilitators to facilitate pacing of the group,

provide individual or group feedbacks, and

attend to any clarifications, needs, issues, and

concerns

Updates on PMDT will be provided



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Participants satisfactorily completing the course

can already be tapped as treatment partners for

DR-TB patients who would continue category IV

treatment at their respective treatment sites.

After the course, decentralization of DR-TB cases

at their respective treatment sites can already

be arranged at the agreed schedule of the

treatment center staff, ntp coordinator,

treatment site personnel, and of the patient.



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PMDT ExpansionRegion TC STC

NCR LCP PHDU

KASAKA

SLH

PTSI TayumanDJNRMH

Gat Andres MMH

Moonwalk HC

Lagrosa HC

Tondo Forshore HCGracepark HC

Lacson HC

Batasan Hills SHC

1 ITRMC Reg. 1 MC

CAR BGHMC4A DLSHSI; BRH Cainta HC

5 SMMGHHSC Bicol MC

6 WVMC; DPOTMH

7 ECS VSMC

9 ZCMC

10 German Doctors ISI PPMD

11 SPMC DRH

12 KCHO

CARAGA CRH


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Stop the Generation of Drug-resistant TB.

Continue Quality DOTSImplementation and Provide

Diagnosis and Treatment to Patients

with Drug resistance.


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Thank You Very Much!